Provider Demographics
NPI:1548530033
Name:GARVAGLIA, MAUREEN THERESE (PTA)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:THERESE
Last Name:GARVAGLIA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N22186 HWY 141
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-9776
Mailing Address - Country:US
Mailing Address - Phone:715-251-1897
Mailing Address - Fax:
Practice Address - Street 1:N22186 HWY 141
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151-9776
Practice Address - Country:US
Practice Address - Phone:715-251-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1098-19261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy